ViewRay magnetic resonance (MR) guided radiotherapy system not only solves the problem of imaging dose,but also can set up accurately,online adaptive radiotherapy and gated irradiation according to magnetic resonance imaging (MRI).The development of this system provides a new technical means of accurate radiotherapy.This review describes the main structure of the ViewRay system,and summarizes quality assurance (QA),dosimetric comparison,respiratory motion management,online adaptive radiotherapy,and preliminary treatment effect.

Objective To investigate the effectiveness and safety of argatroban combined with an-tiplatelet therapy in patients with acute mild-to-moderate atherosclerotic cerebral infarction within 72 hours after symptom onset.Methods A total of 452 patients with large atherosclerotic cerebral infarc-tion were enrolled and divided into two groups.The combined therapy group(n=286)received ar-gatroban combined with antiplatelet therapy,while the control group(n=166)received antiplatelet therapy alone.The National Institutes of Health Stroke Scale(NIHSS)score,modified Rankin Scale(mRS)score,early neurological deterioration(END),and occurrence of bleeding events were com-pared between the two groups using a Logistic regression model.Results Statistically significant differences were observed in age,smoking history,time from stroke onset to admission,low-density lipo-protein,and estimated glomerular filtration rate(eGFR)levels between the two groups(P＜0.05).No significant differences were found in infarction location,responsible artery,and atherosclerotic subtype between the combined therapy and control groups(P＞0.05).Among patients with atheroscleroticcerebral infarction,the proportion of patients with an mRS score of 0 to 2 at 90 days after combined therapy of argatrobanwas 85.3％,and was 74.5％in the control group(P＜0.05).In patients with an NIHSS score ≥3,the proportion of patients with an mRS score of 0 to 2 at 90 days in the combined therapy group was 19.3％,which was significantly lower than 60.8％in the control group(P＜0.05).For anterior circulation responsible artery occlusion,the proportion of patients with an mRS score of 0 to 2 at 90 days in the combined therapy group was 82.1％,and 67.2％in the control group(P＜0.05).Among atherosclerotic subtypes,the proportion of patients with penetrating ar-tery occlusion and an mRS score of 0 to 2 at 90 days was significantly higher in the combined therapy group compared to the control group(P＜0.05).Conclusion Argatroban combined with anti-platelet therapy can improve neurological outcomes in patients with acute mild-to-moderate athero-sclerotic ischemic stroke without increasing the risk of bleeding.The combined therapy offers more pronounced benefits in patients with anterior circulation ischemia and penetrating artery occlusion.

Objective:To describe the characteristics and change trends of incidence, mortality and disease burden of acute myocardial infarction (AMI) in Qingdao from 2014 to 2020.Methods:We analyzed the incidence data of AMI retrieved from Qingdao Chronic Diseases Surveillance System. The average annual percent change (AAPC) of morbidity and mortality of AMI were evaluated by using Joinpoint log-linear regression model. Disability adjusted life year (DALY) was used to estimate disease burden of AMI in Qingdao.Results:A total of 70 491 AMI cases and 50 832 deaths of AMI occurred in Qingdao from 2014 to 2020. The age-standardized morbidity and mortality were 54.71/100 000 and 36.55/100 000, respectively. During 2014-2020, the AAPC of age-standardized morbidity was 2.86% (95% CI: 0.42%-5.35%), and 4.30% (95% CI: 1.24%-7.45%) in men and 0.78% (95% CI: -0.89%-2.47%) in women, respectively. The log-linear regression model showed that age-standardized morbidity in age groups 30-39, 40-49 years increased rapidly, with the AAPCs of 8.92% (95% CI: 2.23%-16.06%) and 6.32% (95% CI: 3.30%-9.44%), respectively. The trend was also observed in age groups 30-39, 40-49 and 50-59 years in men, with the AAPCs of 11.25% (95% CI: 3.54%-19.54%), 6.73% (95% CI: 2.63%-10.99%) and 6.72% (95% CI: 2.98%-10.60%), respectively. There was no significant change in age-standardized mortality. The DALY rate increased from 7.49/1 000 in 2014 to 8.61/1 000 in 2020, with the AAPC of 1.97% (95% CI: 0.36%-3.60%). Conclusions:The age-standardized morbidity of AMI in men increased in Qingdao, especially in those aged 30-49 years, while age-standardized mortality rate of AMI was relatively stable from 2014 to 2020. The burden of disease of AMI increased in both men and women.

Objective To investigate the effectiveness and safety of argatroban combined with an-tiplatelet therapy in patients with acute mild-to-moderate atherosclerotic cerebral infarction within 72 hours after symptom onset.Methods A total of 452 patients with large atherosclerotic cerebral infarc-tion were enrolled and divided into two groups.The combined therapy group(n=286)received ar-gatroban combined with antiplatelet therapy,while the control group(n=166)received antiplatelet therapy alone.The National Institutes of Health Stroke Scale(NIHSS)score,modified Rankin Scale(mRS)score,early neurological deterioration(END),and occurrence of bleeding events were com-pared between the two groups using a Logistic regression model.Results Statistically significant differences were observed in age,smoking history,time from stroke onset to admission,low-density lipo-protein,and estimated glomerular filtration rate(eGFR)levels between the two groups(P＜0.05).No significant differences were found in infarction location,responsible artery,and atherosclerotic subtype between the combined therapy and control groups(P＞0.05).Among patients with atheroscleroticcerebral infarction,the proportion of patients with an mRS score of 0 to 2 at 90 days after combined therapy of argatrobanwas 85.3％,and was 74.5％in the control group(P＜0.05).In patients with an NIHSS score ≥3,the proportion of patients with an mRS score of 0 to 2 at 90 days in the combined therapy group was 19.3％,which was significantly lower than 60.8％in the control group(P＜0.05).For anterior circulation responsible artery occlusion,the proportion of patients with an mRS score of 0 to 2 at 90 days in the combined therapy group was 82.1％,and 67.2％in the control group(P＜0.05).Among atherosclerotic subtypes,the proportion of patients with penetrating ar-tery occlusion and an mRS score of 0 to 2 at 90 days was significantly higher in the combined therapy group compared to the control group(P＜0.05).Conclusion Argatroban combined with anti-platelet therapy can improve neurological outcomes in patients with acute mild-to-moderate athero-sclerotic ischemic stroke without increasing the risk of bleeding.The combined therapy offers more pronounced benefits in patients with anterior circulation ischemia and penetrating artery occlusion.

Objective To understand the factors that affect the pulmonary rehabilitation behavior of elderly patients with lung cancer during the post-operative transitional period,and provide reference bases for formulating the pulmonary rehabilitation plan of elderly patients with lung cancer during the transitional period and improving the compliance of pulmonary rehabilitation.Methods Based on the capability,opportunity,and motivation-behavior model(COM-B model),12 elderly lung cancer patients who underwent surgery at a tertiary A tumor hospital in Tianjin from March to July 2022 were selected for semi-structured interviews using descriptive research methods and purposive sampling method.The data were analyzed using directed content analysis.Results The ability factors(physical strength and postoperative discomfort symptoms of the elderly limit lung rehabilitation exercise,lack of pulmonary rehabilitation knowledge and awareness of the importance of exercise in lung rehabilitation knowledge),opportunity factors(lack of grassroots medical and health services,limiting lung rehabilitation exercise;family and friends are important resources for promoting lung rehabilitation exercise;medical support is a guarantee for promoting lung rehabilitation exercise),motivational factors(high self-efficacy in exercise is the foundation for lung rehabilitation exercise,perception of lung rehabilitation effects increases motivation for lung rehabilitation exercise)and 7 sub themes were extracted.Conclusion There are certain obstacles and promoting factors in the transitional lung rehabilitation process for elderly lung cancer patients after surgery.It is necessary to improve their postoperative discomfort symptoms,increase their knowledge of lung rehabilitation,enhance their awareness of lung rehabilitation,face the social support role of family,friends,and medical staff,improve the infrastructure and lung rehabilitation system,increase community lung rehabilitation support,provide multi-channel high-quality lung rehabilitation resources,and promote the development of smart medical services,constructing a transitional lung rehabilitation strategy for elderly patients with lung cancer.

Objective: To construct and implement a calculation model of clinical nursing post classification. Methods: Between October to December 2018, head nurses of the hospital were screened as consultants, and Delphi method was used to determine the indicators, while the weights were assigned from the aspects of nursing workload, work quality, patient satisfaction and number of nursing night shifts. Combined with HIS data, the calculation model of clinical nursing post classification was constructed to classify clinical nursing units into different categories and levels. Results: After two rounds of expert enquiry, 82 nursing work items were identified and the objective weight assignment was determined ranging from 0.80 to16.14. According to the established calculation model and HIS data, nursing posts in clinical departments were classified into 6 levels and 3 categories, and the accurate management of clinical nursing post classification was achieved. Conclusions The construction of a calculation model is scientific and rigorous, which provides a scientific basis for dynamic nurse performance management and rational allocation of human resources. In addition, it provides a useful reference for accurate nursing management.